As flu cases in the U.S. are rising dramatically, the Centers for Disease Control and Prevention, overseen by the Trump Administration’s Health and Human Services (HHS) Secretary Robert F. Kennedy Jr., a noted vaccine skeptic, announced that it is endorsing fewer routinely-recommended vaccinations for all children.

As part of the new schedule, HHS will no longer broadly recommend influenza, COVID-19, rotavirus, and other previously recommended immunizations. It now recommends 11 vaccines for all children, down from previously recommending vaccinations to protect against 18 different diseases in 2024.

That’s happening as flu cases in the U.S. have reached their highest levels since the COVID-19 pandemic, according to new data from the CDC, with children and teenagers among the worst affected.

“After an exhaustive review of the evidence, we are aligning the U.S. childhood vaccine schedule with international consensus while strengthening transparency and informed consent,” Kennedy said in a press release. “This decision protects children, respects families, and rebuilds trust in public health.”

Restoring trust in the public health system is a key reason behind the move, according to the government. A poll published last February by the AAMC Center for Health Justice found that from 2021 to 2024, public trust in institutions—including medical institutions, social services, fire departments, and others—declined. The decline in trust was sharpest for pharmacies and hospitals. Trust was lowest among members of Gen Z, adults living in rural areas, adults earning lower annual incomes, and individuals with less than a college degree.

But physicians, immunologists, and other medical experts have criticized the move as sowing distrust of vaccines and creating confusion among patients and healthcare providers. Some have argued that it may also lead healthcare providers to recommend fewer vaccinations.

“At a time when parents, pediatricians and the public are looking for clear guidance and accurate information, this ill-considered decision will sow further chaos and confusion and erode confidence in immunizations,” Andrew D. Racine, president of the American Academy of Pediatrics, said in a statement. “This is no way to make our country healthier.”

What’s new?

The CDC organizes childhood immunization recommendations into three categories: recommendations for all children; recommendations for high-risk groups; and recommendations based on “shared clinical decision-making.” The latter category requires patients to consult a healthcare provider before receiving a vaccine.

Under the new schedule, the CDC continues to recommend vaccinations for all children for chickenpox, tetanus, diphtheria, whooping cough, polio, pneumococcal conjugate, Haemophilus influenzae type b (HiB), measles, mumps, and rubella. The schedule also recommends one dose of the human papillomavirus (HPV) shot, as compared to previously recommending two doses.

Respiratory syncytial virus (RSV)—a common respiratory virus affecting the lungs and the leading cause of hospitalizations for infants in the U.S.—is no longer broadly endorsed for all children. Instead, it is now recommended for high-risk groups.

Immunizations for rotavirus, COVID-19, influenza, meningococcal disease, and hepatitis A and B are now based on shared clinical decision-making.

The CDC report reasons that broadly recommending fewer vaccines “allows for more flexibility and choice, with less coercion.” Senior HHS officials reportedly cited “a drop in vaccine uptake of routine vaccinations for children” as a reason for the change. That includes plummeting measles vaccination rates amid several measles outbreaks across the U.S. last year.

No vaccines were taken off the schedule entirely, and all of the vaccines will still be available and covered by the Affordable Care Act and other federal insurance programs.

“No family will lose access,” Dr. Mehmet Oz, the administrator of the Centers for Medicare & Medicaid Services (CMS) said. “This framework empowers parents and physicians to make individualized decisions based on risk, while maintaining strong protection against serious disease.”

The new schedule follows a Dec. 5 presidential memorandum directing the HHS and the CDC to align the list of recommended vaccines in the U.S. with those in “peer, developed countries.” At the same time, the CDC’s vaccine advisors voted to narrow the agency’s hepatitis B recommendation for newborns.

“President Trump directed us to examine how other developed nations protect their children and to take action if they are doing better,” Kennedy said.

Medical experts have criticized the method, arguing that the review took only a month and is based on consensus among peer countries rather than scientific data. The new schedule is more similar to that of Denmark, a country of just 6 million people compared with 343 million in the U.S. For example, the CDC report cites Denmark as being “the first peer nation to remove its universal recommendation of the COVID-19 vaccine for children” in 2022.

“The United States is not Denmark, and there is no reason to impose the Danish immunization schedule on America’s families. America is a unique country, and Denmark’s population, public health infrastructure, and disease-risk differ greatly from our own,” Racine said.

“For decades, leading health experts, immunologists, and pediatricians have carefully reviewed new data and evidence as part of the immunization recommendation process, helping to keep newborns, infants, and children protected from diseases they could be exposed to in the United States as they develop and grow,” Racine added. “Today’s decision, which was based on a brief review of other countries’ practices, upends this deliberate scientific process.”

The report was led by Tracy Beth Høeg, acting director for the Center for Drug Evaluation and Research, and Martin Kulldorff, a chief science and data officer at the HHS. The changes were made in consultation with experts at the CDC, Food and Drug Administration, National Institutes of Health, and CMS. It did not, however, invite formal public comment or consultation with vaccine manufacturers, officials reportedly said.

Public health nonprofit Trust for America’s Health, the Big Cities Health Coalition, and the National Association of County and City Health Officials criticized the move in a joint statement.

“For decades, each change to the schedule was discussed openly by experts, with both benefits and risks considered. However, today’s announcement places increased burden on parents and health providers to navigate an increasingly complex system and assure access to these life-saving products,” the statement said.

Rising flu cases

The new recommendations come amid the first “moderately severe” influenza outbreak of the season in the U.S., according to CDC data released on Monday. The CDC assesses the severity of an outbreak within a season using data beginning from Oct. 1, when influenza activity typically begins to rise. The CDC tracks a flu season from early fall to the following late summer.

At least 11 million people have contracted the flu, 120,000 people have been hospitalized for it, and 5,000 people have died from it this season, according to the CDC. Those numbers may still increase, as the flu season typically continues till May. Last week, New York health officials reported the highest number of flu hospitalizations recorded in a single week, with more than 4,500 hospitalizations in the seven-day period ending Jan. 2.

Read More: When Should I Go to the Doctor With Cold Symptoms?

Children and teenagers have been hit particularly hard, with influenza being the reason for more than 20% of emergency department visits for children aged 5 to 17 and more than 18% of visits for children under the age of 4 in the last week of 2025. Nine children have died so far this season due to the flu. Last flu season, 289 children—most of whom were not fully vaccinated—died due to the flu in the highest levels of pediatric deaths recorded since mandatory tracking began in 2004.

The flu refers to an infection caused by any of four types of influenza viruses A, B, C, and D. Influenza A and B are the most common causes of seasonal outbreaks in humans. Medical experts across the board recommend annual vaccinations to ward off the flu.

Flu symptoms include fever, chills, cough, sore throat, runny or stuffy nose, body aches, headache, tiredness, vomiting, and diarrhea.

Last fall, experts told TIME that lagging vaccination rates were likely responsible for a surge of influenza cases across Asia. Factors like the weather can also impact behavior such as crowding indoors, which can increase the spread of influenza, experts said.

“The key is to stay up to date with vaccinations,” Dr. Paul Tambyah, a former president of the Asia Pacific Society of Clinical Microbiology and Infection, said in October.

“There is still time to get a flu shot and remember, flu can be treated with antiviral medication if started within 48 hours of symptom onset and your doctor deems appropriate,” New York State Health Commissioner Dr. James McDonald said in a statement.

Around 43% of the U.S. population are vaccinated against the flu, the CDC reported on Monday.

The most frequently reported cases of the flu in the U.S. this season have been due to a mutation of the H3N2 strain. Tambyah previously told TIME that because the influenza virus is able to evolve rapidly, having been previously inoculated or infected may not ensure immunity to new variants.

Nevertheless, experts broadly agree that keeping up with vaccinations is the best way to minimize the impact of the flu, including reducing the spread of influenza and protecting against severe infection or death.

“Immunizations are the most effective defense we have against a host of deadly and painful illnesses. Ensuring all children receive the vaccines they need on time stops diseases from spreading in the community and ensures healthy childhood development,” the joint statement from public health nonprofits and coalitions said. “Creating new barriers to immunizations, as today’s announcement does, will make it harder for children to have the opportunity to grow up healthy and strong.”